Conditional Cash Transfer Research Articles

Integrating Gender-Sensitive Health Promotion into Conditional Cash Transfer Program: Advancing Gender Equality and Sustainable Development Goals in Indonesia

Integrating Gender-Sensitive Health Promotion into Conditional Cash Transfer Program: Advancing Gender Equality and Sustainable Development Goals in Indonesia

The Inability to Form a Coalition: The Case of the Basic Income Proposal in Mexico

Abstract The proposal for Basic Income (BI) pushed by renowned figures in Mexico sparked a vigorous debate over social policy between 2015 and 2018. This debate was particularly notable, as it challenged the long-standing dominance of conditional cash transfers, which had remained largely unquestioned as the country’s main antipoverty policy since their introduction in the 1990s. Despite the BI proposal getting wide coverage from the media, it not only failed to gain traction on the government’s agenda but also quickly became irrelevant right after the general elections of 2018. This was due to the unsuccessful coalition-building efforts of the BI proponents, who were unable to reconcile their political disagreements, overcome partisan competition, establish communication, and bridge their policy beliefs on various levels. By conducting interviews with relevant stakeholders, I conclude that the inability of the BI supporters to form a unified advocacy coalition made it impossible to promote social policy change.

Effects of conditional cash transfers and pre-test and post-test tuberculosis counselling on patient outcomes and loss to follow-up across the continuum of care in South Africa: a randomised controlled trial.

Economic and behavioural factors lead to poor outcomes in patients with tuberculosis. We investigated the effects of a package of interventions consisting of pre-test and post-test tuberculosis counselling with conditional cash transfers on patient outcomes in adults undergoing investigation for pulmonary tuberculosis. This pragmatic, open-label, individual randomised controlled trial was done in nine clinics in Johannesburg, South Africa. Participants (aged ≥18 years) undergoing investigation for tuberculosis were randomly assigned (1:1) to the intervention group or control group (standard of care) via permuted block randomisation, stratified by clinic; group assignment was concealed using opaque envelopes. The intervention group received pre-test and post-test tuberculosis counselling, and for participants diagnosed with rifampicin-susceptible tuberculosis, a digital payment (R150; approximately US$10) at treatment initiation and each monthly treatment visit. Payments were contingent on timely attendance: 14 days from initial sputum sample collection and within 7 days on either side of their scheduled monthly appointment. The primary endpoint was successful patient outcome (patients who were cured or completed treatment) or unsuccessful patient outcome (pretreatment loss-to-follow-up, on-treatment loss-to-follow-up, development of rifampicin-resistant tuberculosis while on treatment, treatment failure [ie, smear or culture positive at 5 months or later after commencing treatment], or death). The primary outcome was analysed in the modified intention-to-treat population, defined as all randomly assigned participants with rifampicin-susceptible tuberculosis confirmed before the commencement of tuberculosis treatment. Weighted outcome prevalence, relative risks (RRs), and risk differences were calculated using a multivariable Poisson model with robust standard errors. This trial is registered with the Pan African Clinical Trials Registry (PACTR202410708311054) and is completed. Between Oct 25, 2018, and Dec 9, 2019, 4110 participants were enrolled and randomly assigned, 2059 to the intervention group and 2051 to the control group. 381 (9·3%) participants had microbiologically confirmed rifampicin-susceptible pulmonary tuberculosis (195 [9·5%] of 2059 in the intervention group vs 186 [9·1%] of 2051 in the control group; median age 37 years [IQR 30 to 45], 257 [67·5%] male, 124 [32·5%] female). At study closure, primary outcome data were available for 128 (65·6%) of 195 participants in the intervention group and 139 (74·7%) of 186 participants in the control group. 105 (82·0%) of 128 participants in the intervention group and 93 (66·9%) of 139 participants in the control group had a successful patient outcome; 23 (18·0%) of 128 participants in the intervention group and 46 (33·1%) of 139 participants in the control group had an unsuccessful patient outcome. The weighted regression analysis showed a substantial reduction in the risk of unsuccessful patient outcomes in the intervention group compared with the control group (weighted prevalence 15·9% vs 28·6%; RR in weighted population 0·52, 95% CI 0·33 to 0·82; risk difference in weighted population -14·1 percentage points, 95% CI -23·3 to -4·8). Pretreatment loss to follow-up was lower in the intervention group than in the control group (unweighted population: five [3·9%] of 128 participants vs 22 [15·8%] of 139 participants; risk difference in weighted population -9·6 percentage points, 95% CI -14·9 to -4·2). The package of interventions consisting of pre-test and post-test tuberculosis counselling with conditional cash transfers significantly reduced the risk of unsuccessful tuberculosis patient outcomes, bringing one of the 90-90-90 targets within reach (ie, achieving 90% tuberculosis treatment success). Furthermore, reduction in pretreatment loss to follow-up is expected to reduce transmission and lower incidence of the disease over time. South African Medical Research Council, UK Medical Research Council, and Newton Fund.

A qualitative analysis of unintended effects of a digital conditional cash transfer intervention to encourage healthcare utilization in Southern Madagascar

IntroductionCash transfer interventions, including those using mobile money, are becoming increasingly widespread, particularly in Sub-Saharan Africa. As such interventions can have significant positive and negative unintended consequences, further analyses are needed to identify these consequences.MethodsWe investigated the unintended consequences of a digital conditional cash transfer intervention implemented at fifteen health facilities in Southern Madagascar. The intervention offered partial cost coverage for patients seeking care for potentially life-threatening conditions, accidents and injuries, maternal or pediatric care between February 2021 and June 2022. We conducted a qualitative analysis of in-depth interviews with policymakers, healthcare providers, (non-) beneficiaries of the intervention, and staff that implemented the intervention using reflexive thematic analysis.ResultsWe identified three key positive and three key negative unintended consequences of the intervention. The key positive unintended consequences were: i) improved quality of care, ii) improved interpersonal relationships, including between patients and providers and between healthcare providers, and iii) digital skills development of healthcare providers and increased trust in mobile money. The three key negative consequences we identified were i) facility overcrowding, ii) an increase in costs of care, and iii) cases of hospital imprisonment.ConclusionsDesigners and implementers of future (digital) cash transfer interventions should carefully consider and proactively seek to leverage the positive and mitigate the negative unintended consequences of cash transfer interventions for healthcare such as those highlighted in our work.

Money Matters: Evidence from a Conditional Cash Transfer Scheme on Child Health

Money Matters: Evidence from a Conditional Cash Transfer Scheme on Child Health

Demand side financing for promoting institutional delivery: experiences of Janani Suraksha Yojana in Indian states.

Public expenditure for the improvement of maternal health is crucial in addressing the major social and demographic challenges in developing countries like India. Accordingly, the Government of India initiated the Janani Suraksha Yojana (JSY) in 2005 as a flagship conditional cash transfer scheme to encourage institutional delivery in the country. While the provisions under the JSY remain uniform throughout the country, there are apprehensions that the impact would differ across the states as well as between the rural and urban setups depending on varied socio-economic conditions and local level dynamics. Besides, households' choice of the type of institution (i.e., government versus private healthcare centres) may also change following the implementation of the JSY. This paper examines these two critical but interrelated aspects. Using secondary data compiled mainly from the last two rounds of the National Family Health Survey and estimating panel data econometric models, the paper finds that interactions with health facilitators during pregnancy, and per capita income contribute positively to the increase in institutional delivery in India irrespective of whether the households are located in rural or urban areas. Importantly, the paper does not find any significant role of the JSY in this regard. On the contrary, the JSY encourages households to prefer public toprivate hospitals in both rural and urban areas, whereas preference for private hospitals is positively associated with the household head literacy rate in urban area and health insurance coverage and per capita income in rural areas. The findings suggest greater emphasis on quality enhancement of the government healthcare centres. Besides, active engagement of the health workers should also be encouraged, particularly in mobilising the community towards institutional delivery and linking them effectively with the related initiatives of the government.

Breaking the Cycle: How Conditional Cash Transfers and Other Determinants Affect Child Labour in Indonesia

Economic hardship frequently forms a reason for child labour. This issue obstructs the development of human capital and perpetuates a cycle whereby children involved in works are predisposed to generate future child labourers. This persistence is mostly ascribed to the deeply rooted socioeconomic difficulties experienced by families. Government initiatives such as conditional cash transfers that alleviate the hardship are considered efficacious in addressing these fundamental concerns and reducing the incidence of child labour. However, child labour rates in Indonesia have remained unchanged over the past seven years. This research analyses the impact and effectiveness of conditional cash transfers (CCTs) as a supply-side intervention designed to enhance family welfare and prevent child labour. Employing multinomial logit analysis and Average Treatment Effect on the Treated (ATT), the results consistently indicate that whereas CCTs promote school attendance, they paradoxically increase the probability of youngsters engaging in both education and work.

Strategic Management of the Ministry of Social Affairs in Promoting Self-Reliance and Prosperity Among Beneficiary Families of the Family Hope Program

The Family Hope Program (PKH) is a conditional cash transfer initiative in Indonesia aimed at reducing poverty and improving access to education, health, and welfare services among Beneficiary Families (KPM). Despite its success, ensuring that KPM achieve independence and prosperity remains a key challenge. This study examines the strategic management practices of the Ministry of Social Affairs in promoting self-reliance among KPM. Using a qualitative descriptive approach, data were collected through literature and documentation studies. The analysis focused on the Ministry's planning, implementation, and evaluation processes, alongside the integration of the PENA (Nusantara Economic Hero) empowerment program. Findings reveal that the Ministry employs strategic management from data collection and program distribution to monitoring and evaluation. The PENA program, targeting entrepreneurial development, has enhanced the capacity of KPM to achieve economic independence. However, gaps in resource accessibility and program coverage persist. The study concludes that while strategic management significantly contributes to the effectiveness of PKH, expanding empowerment initiatives and fostering inter-agency collaboration are crucial for achieving broader impacts. Recommendations include extending the PENA program and conducting comprehensive evaluations to guide future policy enhancements.

Effects of conditional cash transfers on tuberculosis incidence and mortality according to race, ethnicity and socioeconomic factors in the 100 Million Brazilian Cohort

Effects of conditional cash transfers on tuberculosis incidence and mortality according to race, ethnicity and socioeconomic factors in the 100 Million Brazilian Cohort

Evaluating Conditional Cash Transfers in the Philippines: A Review of the Pantawid Pamilyang Pilipino Program’s Impact on Poverty Alleviation

The Conditional Cash Transfer (CCT) program is the most important tool globally for poverty reduction efforts; they are conditional cash transfer programs offering targeted financial support to the lowest-income families contingent upon meeting certain requirements of health, education, and social welfare. This review examines the impact of the Philippines’ flagship poverty reduction program, the Pantawid Pamilyang Pilipino Program (4Ps), in terms of health, education, and empowerment. By synthesizing extant literature, the review identifies key themes regarding the beneficiaries’ perceptions of success, their degree of satisfaction with the program, and its general role in poverty alleviation. The results suggest that success among the beneficiaries does not only relate to economic benefits but also encompasses education, increased family well-being, and active participation in the community. The perceived quality of implementation of the program is a critical determinant in shaping the satisfaction of its beneficiaries and the overall effectiveness of the program. The review concludes with actionable recommendations for improving 4Ps, including strengthening the monitoring and evaluation mechanisms and finding gaps in service delivery. Finally, it suggests several avenues for future research to more clearly understand the nuanced impacts CCT programs have on the lives of beneficiaries and the broader socio-economic outcomes.

Educational Policy in Nigeria: Analyzing the Impact of the 9-Year Basic Education Policy on School Enrollment and Retention Rates

This paper explores the 9-Year Basic Education Policy in Nigeria, analyzing its impact on school enrollment and retention rates. The policy, introduced to improve access to education, faces several challenges, including financial constraints, teacher shortages, and cultural barriers, particularly for girls in rural areas. The paper examines the key interventions made by the government, such as conditional cash transfers, scholarships, and school feeding programs, which aim to improve retention. It also discusses the role of community engagement and local education authorities in sustaining educational reforms. By comparing Nigeria’s efforts with similar reforms in other African countries, the paper assesses the long-term effects on educational outcomes, especially the reduction in dropout rates. Lastly, the paper offers recommendations for future educational reforms in Nigeria, focusing on infrastructure improvements, teacher development, and gender equality to ensure the sustainability and success of the policy.

Teenage Pregnancy in India: Addressing Ethical Dilemmas

Teenage pregnancy remains a significant public health and social concern in India. This article examines the prevalence, contributing factors, and consequences of teenage pregnancy in India and explores the important ethical dilemma associated in context of pregnancy care in public health program and teenage pregnancy. Key factors for the teenage pregnancy include early marriage, lack of education, poverty, limited contraceptive use, and cultural norms. Teenage pregnancies are associated with higher maternal and infant mortality, pregnancy complications, and poor socioeconomic outcomes. While national programs address maternal health broadly, there is a lack of targeted interventions for teenage pregnancies, creating an ethical dilemma where this vulnerable group is left exposed to adverse events and outcomes. Additionally, teenagers under 18 are often excluded from key support programs, like conditional cash transfers, leaving them without essential resources. This article highlights the need for comprehensive strategies, including improved adolescent sexual education, behavior change communication, and specific support programs for pregnant teenagers. Addressing teenage pregnancy requires a multifaceted approach targeting social determinants, healthcare access, and cultural attitudes.

A study to assess the awareness and utilization regarding government scheme “Janani Suraksha Yojana” (JSY) among general public in New Delhi

Maternal health remains a pressing public health challenge in India, with high maternal and neonatal mortality rates influenced by poverty, limited healthcare access, and cultural barriers. To address these issues, the Government of India introduced the Janani Suraksha Yojana (JSY) in 2005, a conditional cash transfer program promoting institutional deliveries to reduce mortality rates. Despite its significance, awareness and utilization of the scheme remain low among the public. So, in this concern an quantitative and descriptive research was conducted, the aim of the study aimed to evaluate the awareness and utilization of JSY among attendees of the antenatal outpatient department at Lal Bahadur Shastri Hospital, New Delhi with 112 participants selected through convenient sampling. Data were gathered using a structured questionnaire distributed via a Google Form link and Bar Code. The data were analyzed using descriptive statistics, including frequencies, percentages, means, and chi-square tests. The results revealed that 57.1% of respondents were unaware of JSY, and 77.7% had not utilized the scheme. No significant association was found between demographic factors and awareness levels. Knowledge regarding Janani Suraksha Yojna was disseminated through charts, posters, pamphlets and nukkad natak among the general public. The study highlights the need to increase awareness and utilization of JSY among the general public in New Delhi. Health education programs and awareness campaigns can be implemented to promote the scheme and improve maternal and child health outcomes.

Are Conditional Cash Transfer Programs the Answer to Social Inequalities in Rural Education? Insights from Morocco’s Tayssir Program

This study examines the impact of the Tayssir Cash Transfer Program on school participation and academic achievement in rural Morocco, with a focus on the village of Sidi Bouabdelli. It complements existing quantitative evaluations by providing a qualitative analysis of how the program influences students’ educational experiences and encourages rural parents to send their children to school. Through observations and interviews with parents, teachers, and students, the study finds that the program significantly increased school attendance, particularly among girls, with financial support linked to greater participation. Parents were more engaged in ensuring regular attendance, and teachers observed improved classroom dynamics. However, academic achievement did not improve, revealing a gap between increased attendance and learning outcomes. The study highlights that financial incentives alone cannot address deep-rooted educational inequalities and calls for a strategy combining financial support with efforts to improve educational quality. Using the Capabilities Approach and Bourdieu’s theory of capital, the study advocates for reforms that enhance access and ensure meaningful educational experiences for marginalized rural children. Future research should employ larger sample sizes and examine multiple case studies to gain a more comprehensive understanding of the Tayssir program’s effects on school attendance and academic achievement across different regions.

Child Well-Being, Family Functioning, and Contextual Strain: A Study of Multi-Assisted Low-Income Families.

This study aimed to examine the effects of poverty on child well-being and family functioning among low-income families. Specifically, it explored the role of parental stress, family dynamics, and contextual strain on children's behavioral and emotional outcomes. Using a sample of families receiving welfare support, the research sought to assess the impact of conditional cash transfer programs and the involvement of Child Protective Services on child development and family well-being. This cross-sectional study involved 99 children aged 8-12 from low-income, welfare-assisted families recruited from the Porto Metropolitan Area. Parental stress, parenting attitudes, family functioning, and child outcomes were assessed using standardized questionnaires. Families with and without Child Protective Services involvement were compared, and a cumulative index of contextual strain was developed to measure the multidimensional impact of stressors on child outcomes. The results revealed that 53% of children exhibited clinical or borderline internalizing behaviors, 47% showed externalizing behaviors, and 39% experienced low psychological well-being. High levels of parental stress, low parenting competence, and significant contextual strain were associated with poorer child outcomes. Families involved with Child Protective Services showed no significant differences in parent or family characteristics, but children from these families exhibited fewer behavioral problems. The study highlights the pervasive impact of poverty and contextual strain on child development, emphasizing the need for more comprehensive interventions. Family functioning and parental stress are critical factors influencing child well-being, pointing to the importance of addressing these areas through targeted welfare and support programs to reduce the intergenerational transmission of poverty and improve child outcomes.

Exploring Which Public Health Interventions Are More Effective to Reduce Maternal and Child Health Inequalities in South Asia: A Systematic Literature Review

Background: Maternal and child health disparities remain a pressing public health concern in South Asia. This systematic review addresses a critical gap in the literature by evaluating the effectiveness of public health interventions targeting these disparities in Bangladesh, India, and Pakistan. Distinguishing itself from prior studies, this research provides a thorough examination of the combined effects of community-based programs, financial assistance, and nutritional supplementation, offering a fresh and comprehensive perspective on strategies to reduce health inequities in the region. Methods: A systematic review and narrative synthesis were conducted using databases such as PubMed and Medline, covering articles published between 2000 and 2019. The inclusion criteria focused on observational and experimental studies evaluating interventions aimed at improving maternal and child health. The quality of the studies was assessed using the CASP checklists. Results: The review included 19 studies that demonstrated significant reductions in maternal and child health disparities. Key interventions included demand-side financial assistance, community education, and nutritional supplements. For example, Iron Folic Acid (IFA) supplementation, combined with antenatal care and tetanus toxoid vaccination, significantly reduced postnatal and under-5 mortality (OR = 0.66, 95% CI: 0.45–0.98). Another study reported a 30% reduction in the maternal mortality rate (MMR) among targeted populations. Discussion: Integrating mental health support within maternal healthcare is crucial to addressing exacerbated vulnerabilities. Effective public health initiatives—including financial aid, community-based programs, and improved healthcare services—have demonstrated potential in reducing these disparities. Policy recommendations include combining nutritional supplementation with antenatal care, expanding conditional cash transfer schemes, and enhancing mental health services. Conclusion: Community-based and targeted interventions are essential for reducing health disparities. Policies should prioritize integrated care models, targeted subsidies, and enhanced mental health services to achieve sustainable improvements in maternal and child health outcomes.

Implementing Project Monitoring and Evaluation Plan with Beneficiaries for Improving Performance: Evidence from Tanzania Conditional Cash Transfer

The study assessed the influence of households’ involvement in the implementation of the Monitoring and Evaluation (M&E) plan on the performance of the Tanzania Conditional Cash Transfer Project (CCTP). The study used the mixed method whereby the sample size was 400 heads of households while purposive sampling enabled to obtain 8 Village Committees and 8 Monitoring Officers. Quantitative data was analysed using Pearson’s correlation and regression model while qualitative data was analysed using content analysis. The study established a significant influence between households’ involvement in the implementation of the M&E plan (t= 8.472, p-value =.000) on the performance of the Tanzania CCTP. It was recommended therefore that the Tanzania CCTP M&E policy should be reviewed to ensure it is vital for households’ involvement in the M&E cycle. The research recommended further study on the organizational practice and level of use of M&E information for further improving performance.

Interventions to Enhance Facility Deliveries in Low- and Middle-Income Countries: A Scoping Review.

The objectives of this review were to identify and map evidence of interventions to enhance facility deliveries in low- and middle-income countries (LMICs). A search for all relevant existing reports in the literature was conducted in December 2020 using the following online bibliographic databases: PubMed, EMBASE, and CENTRAL. A manual search of the reference lists of relevant systematic reviews and all identified studies was performed to identify additional studies. Two reviewers independently screened the titles and abstracts of the retrieved studies, and then screened the full text identified as inclusion in the initial screening. The search of electronic databases and hand searching identified a total of 6682 articles. A total of 40 reports were identified for full-text review, and 31 reports were excluded. Finally, nine trials were included in the scoping review, and a total of 29,892 women were included in this review. Of nine trials, one was conducted in Nepal, and the other eight trials were performed in Africa: Kenya, Uganda, Nigeria, Tanzania, and Zambia. Our review found the following effective interventions to enhance facility deliveries: group antenatal care (ANC), birth plans, full vouchers, conditional cash transfers (CCTs), non-monetary incentives, and short message service (SMS). Women who received group ANC, promotion of birth plans, full vouchers, CCTs, non-monetary incentives, and SMS were significantly more likely to deliver at a facility.

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme.

Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders. This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10). BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Do conditional cash transfers improve intergenerational gains in educational achievement?: Evidence from Brazil’s Bolsa Familia Program

Do conditional cash transfers improve intergenerational gains in educational achievement?: Evidence from Brazil’s Bolsa Familia Program